Aortic stenosis risk factors: Difference between revisions

Jump to navigation Jump to search
 
(56 intermediate revisions by 14 users not shown)
Line 1: Line 1:
__NOTOC__
{| class="infobox" style="float:right;"
|-
| [[File:Siren.gif|30px|link=Aortic stenosis resident survival guide]]|| <br> || <br>
| [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Aortic stenosis}}
{{Aortic stenosis}}
{{CMG}}; '''Associate Editors-In-Chief:''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]; [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com]; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]]; [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org] '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@perfuse.org]
{{CMG}}; '''Associate Editors-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]


==Overview==
==Overview==
Aortic stenosis is not generally understood to be a preventable condition. However, some characteristics may incline certain patients to acquire aortic stenosis compared to their healthy counterparts. The most common risk factor for aortic stenosis arises from the congenital condition, [[bicuspid aortic valve|bicuspid aortic valve syndrome]]. Prophylaxis therapy may be used as a preventative mechanism in impeding potential disease onset.
The most common [[risk factor]] for the development of aortic stenosis is the presence of a congenital [[bicuspid aortic valve]]. Risk factors that may speed up the progression of aortic stenosis include the same [[risk factors]] as [[atherosclerosis]].


==Risk factors==
==Risk Factors==
Some of the risk factors for aortic stenosis include:


*Age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases).
=== '''Common Risk Factors''' ===
*Congenital bicuspid aortic valve that may get calcified later in (30-40% of cases).
Common risk factors in the development of aortic stenosis include:<ref name="pmid20579534">{{cite journal| author=Siu SC, Silversides CK| title=Bicuspid aortic valve disease. | journal=J Am Coll Cardiol | year= 2010 | volume= 55 | issue= 25 | pages= 2789-800 | pmid=20579534 | doi=10.1016/j.jacc.2009.12.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20579534  }} </ref><ref name="pmid11794152">{{cite journal| author=Mylonakis E, Calderwood SB| title=Infective endocarditis in adults. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 18 | pages= 1318-30 | pmid=11794152 | doi=10.1056/NEJMra010082 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11794152  }} </ref><ref name="Lugiano-2013">{{Cite journal | last1 = Lugiano | first1 = CA. | title = Aortic stenosis. | journal = JAAPA | volume = 26 | issue = 11 | pages = 46-7 | month = Nov | year = 2013 | doi = 10.1097/01.JAA.0000436518.69169.8e | PMID = 24153092 }}</ref><ref name="pmid26227196">{{cite journal| author=Pawade TA, Newby DE, Dweck MR| title=Calcification in Aortic Stenosis: The Skeleton Key. | journal=J Am Coll Cardiol | year= 2015 | volume= 66 | issue= 5 | pages= 561-77 | pmid=26227196 | doi=10.1016/j.jacc.2015.05.066 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26227196  }} </ref>
*Acute [[rheumatic fever]] (less than 10% of cases).
*Congenital [[bicuspid aortic valve]] that may subsequently become calcified later in life
*Acute [[rheumatic fever]]
*[[Calcific aortic valve disease|Age-related progressive calcification]] of the normal tricuspid aortic valve


Other risk factors that may speed up the disease process include:
==='''Less common Risk Factors'''===
*[[Hypertension]].
Less common risk factors in the development of aortic stenosis include:<ref name="pmid3565291">{{cite journal| author=Aronow WS, Schwartz KS, Koenigsberg M| title=Correlation of serum lipids, calcium, and phosphorus, diabetes mellitus and history of systemic hypertension with presence or absence of calcified or thickened aortic cusps or root in elderly patients. | journal=Am J Cardiol | year= 1987 | volume= 59 | issue= 9 | pages= 998-9 | pmid=3565291 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3565291  }} </ref><ref name="pmid7925504">{{cite journal| author=Lindroos M, Kupari M, Valvanne J, Strandberg T, Heikkilä J, Tilvis R| title=Factors associated with calcific aortic valve degeneration in the elderly. | journal=Eur Heart J | year= 1994 | volume= 15 | issue= 7 | pages= 865-70 | pmid=7925504 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7925504  }} </ref><ref name="pmid10323772">{{cite journal| author=Olsson M, Thyberg J, Nilsson J| title=Presence of oxidized low density lipoprotein in nonrheumatic stenotic aortic valves. | journal=Arterioscler Thromb Vasc Biol | year= 1999 | volume= 19 | issue= 5 | pages= 1218-22 | pmid=10323772 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10323772  }} </ref><ref name="pmid3696315">{{cite journal| author=Maher ER, Pazianas M, Curtis JR| title=Calcific aortic stenosis: a complication of chronic uraemia. | journal=Nephron | year= 1987 | volume= 47 | issue= 2 | pages= 119-22 | pmid=3696315 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3696315  }} </ref>
*[[Diabetes mellitus]].
*[[Diabetes mellitus]]
*[[Hyperlipoproteinemia]].
*[[High cholesterol]]
*[[Uremia]].
*[[Hypertension]]
* [[Low HDL]]
*[[Uremia]]


Normal aortic valve have three leafs (tricuspid), but some valves have two leafs (bicuspid). Typically, aortic stenosis due to calcification of a bicuspid valve appears earlier, in the 40s and 50s, whereas that due to calcification of a normal valve appears later, in the 70s and 80s.
==='''Other Risk Factors'''===
 
Some other [[risk factors]] of aortic stenosis include:<ref name="pmid14657067">{{cite journal| author=Hull MC, Morris CG, Pepine CJ, Mendenhall NP| title=Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. | journal=JAMA | year= 2003 | volume= 290 | issue= 21 | pages= 2831-7 | pmid=14657067 | doi=10.1001/jama.290.21.2831 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14657067  }} </ref><ref name="pmid7484833">{{cite journal| author=Gotoh T, Kuroda T, Yamasawa M, Nishinaga M, Mitsuhashi T, Seino Y et al.| title=Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study). | journal=Am J Cardiol | year= 1995 | volume= 76 | issue= 12 | pages= 928-32 | pmid=7484833 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7484833  }} </ref><ref name="pmid21737022">{{cite journal| author=Linefsky JP, O'Brien KD, Katz R, de Boer IH, Barasch E, Jenny NS et al.| title=Association of serum phosphate levels with aortic valve sclerosis and annular calcification: the cardiovascular health study. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 3 | pages= 291-7 | pmid=21737022 | doi=10.1016/j.jacc.2010.11.073 | pmc=PMC3147295 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21737022  }} </ref>
==Precautions==
*[[Radiation therapy]] for cancer, such as [[breast cancer]] or [[lymphoma]]
People with aortic stenosis of any aetiology are at risk for the development of infection of their stenosed valve, i.e. [[infective endocarditis]]. To lessen the chance of developing that serious complication, people with AS are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of [[esophageal varices]], dilation of [[esophageal stricture]]s, gastrointestinal ''surgery'' where the intestinal [[mucosa]] will be disrupted, [[prostate]] surgery, [[urethral stricture]] dilation, and [[cystoscopy]]. Note that routine upper and lower GI [[endoscopy]] (i.e. [[gastroscopy]] and [[colonoscopy]]), with or without [[biopsy]], are not usually considered indications for antibiotic prophylaxis.
* High [[lipoprotein a]]
 
* Disorders of [[calcium]] metabolism
Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:
*Those with prosthetic heart valves.
*Those with previous episode(s) of [[endocarditis]].
*Those with certain types of [[congenital heart disease]] <ref>http://www.americanheart.org/presenter.jhtml?identifier=4436</ref>.
 
Since the stenosed aortic valve may limit the heart's output, people with aortic stenosis are at risk of [[syncope]] and dangerously low blood pressure should they use any of a number of common medications. Ironically, these same medicines are used to treat a variety of cardiovascular diseases, many of which may co-exist with aortic stenosis. Examples include [[nitroglycerin]], [[nitrates]], [[ACE inhibitor]]s, [[terazosin]] (Hytrin), and [[hydralazine]]. Note that all of these substances lead to peripheral [[vasodilation]]. Normally, however, in the absence of aortic stenosis, the heart is able to increase its output and thereby offset the effect of the dilated blood vessels. In some cases of aortic stenosis, however, due to the obstruction of blood flow out of the heart caused by the stenosed aortic valve, [[cardiac output]] cannot be increased. Low blood pressure or [[syncope]] may ensue.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


{{WH}}
{{WS}}
[[CME Category::Cardiology]]


{{Circulatory system pathology}}
[[Category:Disease]]
{{Congenital malformations and deformations of circulatory system}}
 
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Overview complete]]
[[Category:Template complete]]
[[Category:Disease state]]
[[Category:Valvular heart disease]]
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Congenital heart disease]]
[[Category:Mature chapter]]
[[Category:Cardiac surgery]]
 
[[Category:Surgery]]
[[es:Estenosis aórtica]]
[[fr:Rétrécissement aortique]]
[[pl:Stenoza Aortalnej]]
[[pt:Estenose aórtica]]
[[ro:Stenoza Aortică]]
[[tr:Aort darlığı]]
 
{{WH}}
{{WS}}

Latest revision as of 19:49, 3 March 2020



Resident
Survival
Guide

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic stenosis risk factors On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic stenosis risk factors

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic stenosis risk factors

CDC on Aortic stenosis risk factors

Aortic stenosis risk factors in the news

Blogs on Aortic stenosis risk factors

Directions to Hospitals Treating Aortic stenosis risk factors

Risk calculators and risk factors for Aortic stenosis risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D. [2]; Usama Talib, BSc, MD [3] Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Overview

The most common risk factor for the development of aortic stenosis is the presence of a congenital bicuspid aortic valve. Risk factors that may speed up the progression of aortic stenosis include the same risk factors as atherosclerosis.

Risk Factors

Common Risk Factors

Common risk factors in the development of aortic stenosis include:[1][2][3][4]

Less common Risk Factors

Less common risk factors in the development of aortic stenosis include:[5][6][7][8]

Other Risk Factors

Some other risk factors of aortic stenosis include:[9][10][11]

References

  1. Siu SC, Silversides CK (2010). "Bicuspid aortic valve disease". J Am Coll Cardiol. 55 (25): 2789–800. doi:10.1016/j.jacc.2009.12.068. PMID 20579534.
  2. Mylonakis E, Calderwood SB (2001). "Infective endocarditis in adults". N Engl J Med. 345 (18): 1318–30. doi:10.1056/NEJMra010082. PMID 11794152.
  3. Lugiano, CA. (2013). "Aortic stenosis". JAAPA. 26 (11): 46–7. doi:10.1097/01.JAA.0000436518.69169.8e. PMID 24153092. Unknown parameter |month= ignored (help)
  4. Pawade TA, Newby DE, Dweck MR (2015). "Calcification in Aortic Stenosis: The Skeleton Key". J Am Coll Cardiol. 66 (5): 561–77. doi:10.1016/j.jacc.2015.05.066. PMID 26227196.
  5. Aronow WS, Schwartz KS, Koenigsberg M (1987). "Correlation of serum lipids, calcium, and phosphorus, diabetes mellitus and history of systemic hypertension with presence or absence of calcified or thickened aortic cusps or root in elderly patients". Am J Cardiol. 59 (9): 998–9. PMID 3565291.
  6. Lindroos M, Kupari M, Valvanne J, Strandberg T, Heikkilä J, Tilvis R (1994). "Factors associated with calcific aortic valve degeneration in the elderly". Eur Heart J. 15 (7): 865–70. PMID 7925504.
  7. Olsson M, Thyberg J, Nilsson J (1999). "Presence of oxidized low density lipoprotein in nonrheumatic stenotic aortic valves". Arterioscler Thromb Vasc Biol. 19 (5): 1218–22. PMID 10323772.
  8. Maher ER, Pazianas M, Curtis JR (1987). "Calcific aortic stenosis: a complication of chronic uraemia". Nephron. 47 (2): 119–22. PMID 3696315.
  9. Hull MC, Morris CG, Pepine CJ, Mendenhall NP (2003). "Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy". JAMA. 290 (21): 2831–7. doi:10.1001/jama.290.21.2831. PMID 14657067.
  10. Gotoh T, Kuroda T, Yamasawa M, Nishinaga M, Mitsuhashi T, Seino Y; et al. (1995). "Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study)". Am J Cardiol. 76 (12): 928–32. PMID 7484833.
  11. Linefsky JP, O'Brien KD, Katz R, de Boer IH, Barasch E, Jenny NS; et al. (2011). "Association of serum phosphate levels with aortic valve sclerosis and annular calcification: the cardiovascular health study". J Am Coll Cardiol. 58 (3): 291–7. doi:10.1016/j.jacc.2010.11.073. PMC 3147295. PMID 21737022.

Template:WH Template:WS CME Category::Cardiology